Prescription Medication and/or Over the Counter Medication Release: If your child is taking prescription or over the
counter medication while attending camp, the Families United staff must have permission to disperse that
medication. I hereby give the Families United health care staff/counselors permission to administer prescription
medications as directed by the prescribing physician and described on the form to my child while attending camp.
Every effort is made to keep your child healthy and safe, illness and injuries can sometimes occur. Should a medical
emergency occur, you will be notified immediately. If we are unable to reach you and your child needs medical
attention, your child will be transported to the Washington Memorial County Hospital, Potosi, MO and treated by the
physician on duty.
By signing the following authorizations you are giving your consent in advance for medical treatment.
Emergency Treatment Release
I grant permission to have my son/daughter or ward treated, in the event of an illness or injury, at a medical facility.
In the event I cannot be reached, I give permission to the physician selected by the Trout Lodge Camp to secure and
administer proper medical treatment, hospitalize, order injection, anesthesia, or surgery for the participant.
Furthermore, I hereby state that I am aware and accept the risk inherent in the program activity. The undersigned
does herby agree to hold harmless and indemnify the Families United, and the Trout Lodge Camp, their officers,
agents, and employees, from any and all liability, loss, actions, or those of this participant, in the course of the camp.
I agree to reimburse the Families United for any expense that may incur for medical treatment at Washington
Memorial County Hospital, Potosi, MO. The Washington Memorial Cou